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Mainstream, VOL LVIII No 25, New Delhi, June 6, 2020

Time to think about the history of Hand Washing | Jos Chathukulam

Saturday 6 June 2020


by Jos Chathukulam

By now most of us have become very vigilant about washing our hands with soap or sanitizers as it is widely touted as an effective strategy to contain the spread of the novel Coronavirus. As the world grapples with the deadly pandemic, hand washing has turned out to be the definitive public health practice that needs to be religiously adopted in our daily lives.

According to the guidelines issued by the World Health Organization (WHO), a proper hand wash involves lathering soap and scrubbing both hands for at least 20 seconds. In a bid to contain the Coronavirus, the government also launched a mass hand washing campaign as part of ‘Breaking the Chain’ of infection.

The history of hand washing is a fascinating one. Some say hand washing has a 220-year old history while others believe that, as a life-saving measure, it came into prominence only in 1847. For most of us, it would be hard to digest that until the mid – 1800s, doctors didn’t bother to wash their hands. Those were times when doctors would go from dissecting a cadaver to delivering a child without even washing their hands. During the period, there was a common mistaken belief that the dirtier the doctor, the better his skills. After conducting a surgery, or performing an autopsy, it was a matter of pride for doctors to walk around in their coats stained with blood and head off straight to maternity wards to attend to pregnant women. While these claims may sound too good to be true, history says otherwise. In1843 Oliver Wendall Holmes, an American Physician argued that doctors with dirty or unhygienic hands could cause postpartum infections such as childbed fever in their patients.

Meanwhile, in 1847, a Hungarian doctor Ignaz Semmelweis, who is widely known as the father of hand washing, came up with some convincing findings to corroborate the life – saving power of hand washing. Dr. Semmelweis, worked as an assistant to Professor Johann Klein, in the first obstetrical clinic of the Vienna General Hospital, Austria.
In the mid 1800s, obstetrical clinics were set up all over Europe to address the issue of infanticide of illegitimate children. It also offered care for the infants and health facility preferred by under privileged women. The mid 1800s also witnessed an alarming rise in maternal mortality resulting from Childbed fever (Puerperal fever)

Two maternity clinics were set up at the Vienna General Hospital. According to an article in the Journal of the Royal Society of Medicine, between 1840 and 1846, the maternal mortality rate in the second clinic run by mid – wives was 36.2 per 1000 births. In the first clinic, run by doctors, it was 98.4 per 1000 births. The bad reputation of the first clinic was known to all and, as a result, woman preferred to get admitted in the second clinic. In fact, Dr.Semmelweis himself wrote that women even begged on their knees not to be admitted to the first clinic. Some women even preferred to give birth on the streets as they found it safer than the first clinic.

All these incidents created some doubts in the minds of Dr. Semmelweis. First, he noticed that Puerperal fever was rare even among women who gave birth on the streets when compared with women who gave birth in the obstetrical clinics. Dr.Semmelweis was deeply upset about the higher mortality rate at the first clinic due to Puerperal fever. The fact that the rate of maternal death was less in the midwife run clinic when compared with a doctor led maternity ward was something that needs to be taken seriously. Germs or presence of germs were not discovered at that time and in those days, it was widely believed that the Puerperal fever was spread by ‘miasma’ – foul smells in the air emanating from rotting corpses and sewage.

Eventually, Dr.Semmelweis figured out that it had something to do with the hygiene of doctors. The trainee doctors at the Vienna General Hospital used to spend time in morgue to dissect corpses to figure out the cause of death. From the morgue they used to straight away head to maternity ward to deliver a baby without washing their hands.
In 1847, Dr.Semmelweis friend Jacob Kolletschka died due to an infection after he cut his finger on a scalpel during an autopsy. The autopsy on Kolletschka’s own body showed a pathology similar to that of women who were dying from Puerperal fever. This incident made Dr. Semmelweis realise that the cadaverous particles from the morgue were the real culprits. He was of the opinion that cadaverous particles on the hands of the doctors were making their way into the bodies of women during childbirth.

To make sure whether this is the underlying cause behind the maternal deaths following child birth, he asked doctors to wash their hands and instruments in chlorinated lime water. Prior to washing hands by doctors, the maternal mortality rate stood at 18.3 per cent. After doctors started washing hands with chlorinated lime water, it dropped to 2.2 per cent.

Despite positive results, fellow medical professionals discarded the solution he offered for a grave health issue. He was ridiculed and other doctors took it as an offence, when Dr.Semmelweis suggested that the unhygienic practices of doctors were to be blamed for deaths. Some even suggested that he was obsessed with washing hands. He even lost his job, suffered a nervous breakdown and tragically died in a psychiatric institution at the age of 47.

In 1860, Florence Nightingale wrote, “Every nurse ought to be careful to wash her hands very frequently during the day”. It was only after Robert Koch and Louis Pasteur came up with the Germ Theory, it was widely accepted that Germs are a real thing that can cause infection and at times death. Pasteur credited Dr.Semmelweis in his work connecting Germ Theory to disease. In 1867, German scientist Robert Koch discovered anthrax bacillus, which gave birth to medical bacteriology. Eventually, bacteria causing Cholera and Tuberculosis were identified.

Between 1890 and 1900, also known as hygiene centric era, not only medical professionals, but also the common people accepted hand washing as a practice to be taken seriously. Towards the dawn of the 20th century, vaccines and antibiotics were developed to put an end to the bacterial diseases.

The 1980s saw the emergence of HIV and food borne illnesses which made people realize that if they do not adopt a hygienic life, it will cost them their life. Then came a string of deadly diseases from SARS to MERS to the latest COVID – 19. The current pandemic has once again reinforced the importance of hand washing to keep it at bay.

Professor, Sri Ramakrishna Hegde Chair, Institute for Social and Economic Change (ISEC), Bengaluru

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